PERSPECTIVES OF MENTAL HEALTH NURSING.pptx

health is a state of physical mental social and spiritual well being and not merely absence of any disease or infirmity

1. Unit-1 Perspectives of mental health nursing Saroj Lal Ji Mehrotra Global Nursing College Amritanshu Chanchal

2. MENTAL HEALTH Mental health is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community. It is an integral component of health and well-being that underpins our individual and collective abilities to make decisions, build relationships and shape the world we live in. Mental health is a basic human right. And it is crucial to personal, community and socio-economic development.

3. Cognitive health Our thoughts are constantly running in the background like a radio. In fact, a recent  study  discovered we have over 6,000 thoughts on average per day. These thoughts are often so automatic that we don’t stop to recognize them for what they are just thoughts prone to error and bias, and not at all a reflection of objective truth .

4. Emotional health Our emotions help motivate us to take action in line with our goals and values. They motivate us to seek out meaningful experiences, avoid danger and embarrassment, and much more. They can be a helpful source of information. But just like our thoughts, they can be biased and misleading. We might sense danger when we’re actually safe and vice versa.

5. Behavioral health Behavioral health can be qualified by things like how engaged you are with the world around you, how well you’re functioning, the quality of your relationships, and the degree to which you feel a sense of belonging and community. Learning to effectively manage your thoughts and emotions will in turn improve your behavioral health. Right-sizing your fears and riding the waves of your emotions will empower you to engage with the world around you instead of avoiding new or challenging situations.

6. Characteristics of Mental Health Mental health is more than just the absence of mental illness. It includes how you feel about yourself and how you adjust to life events. However, the National Mental Health Association cites 10 characteristics of people who are mentally healthy. They feel good about themselves. They do not become overwhelmed by emotions, such as fear, anger, love, jealousy, guilt, or anxiety. They have lasting and satisfying personal relationships. They feel comfortable with other people. They can laugh at themselves and with others.

7. They have respect for themselves and for others even if there are differences. They are able to accept life’s disappointments. They can meet life’s demands and handle their problems when they arise. They make their own decisions. They shape their environment whenever possible and adjust to it when necessary.

8. Mental illness A mental disorder is characterized by a clinically significant disturbance in an individual’s cognition, emotional regulation, or behaviour .  It is usually associated with distress or impairment in important areas of functioning. There are many different types of mental disorders.  Mental disorders may also be referred to as mental health conditions. The latter is a broader term covering mental disorders, psychosocial disabilities and (other) mental states associated with significant distress, impairment in functioning, or risk of self-harm.  This fact sheet focuses on mental disorders as described by the International Classification of Diseases 11th Revision (ICD-11).

9. Signs of mental illness unusual or illogical thoughts unreasonable  anger  or irritability poor concentration and memory, not being able to follow a conversation hearing voices that no one else can hear increased or  decreased sleep increased or low appetite, or preoccupation with control over food, calories or excessive exercise

10. lack of motivation withdrawing from people drug use feelings that life is not worth living or  suicidal thoughts becoming obsessed with a topic, like death or religion not looking after personal hygiene or other responsibilities not doing as well as usual at school or work

11. Vision As per Census 2011, there are 15,05,624 mentally challenged persons in the country. The vision of the National Mental Health Policy is to promote mental health, prevent mental illness, enable recovery from mental illness, promote de-stigmatization and desegregation, and ensure socio-economic inclusion of persons affected by mental illness by providing accessible, affordable and quality health and social care to all persons through their life-span within a rights-based frame work.

12. Goals of the policy To reduce distress, disability, exclusion morbidity and premature mortality associated with mental health problems across life span of the person. To enhance understanding of the mental health in the country. To strengthen the leadership in the mental health sector at the national, state and district levels.

13. Objectives of the Policy To provide universal access to mental health care. To increase access to and utilisation of comprehensive mental health services by persons with mental health problems. To increase access to mental health care especially to vulnerable groups including homeless persons, persons in remote areas, educationally, socially and deprived sections. To reduce prevalence and impact of risk factors associated with mental health problems. To reduce risk and incidence of suicide and attempted suicide.

14. To ensure respect for rights and protection from harm of persons with mental health problems. To reduce stigma associated with mental health problems. To enhance availability and equitable distribution of skilled human resources for mental health. To progressively enhance financial allocation and improve utilisation for mental health promotion and care. To identify and address the social, biological and psychological determinants of mental health problems and to provide appropriate interventions.

15. Background To address the huge burden of mental disorders and shortage of qualified professionals in the field of mental health, Government of India has been implementing National Mental Health Program (NMHP) since 1982. The district Mental Health Program was added to the Program in 1996. The Program was re-strategized in 2003 to include two schemes, viz. Modernization of State Mental Hospitals and Up-gradation of Psychiatric Wings of Medical Colleges/General Hospitals. The Manpower development scheme (Scheme-A & B) became part of the Program in 2009.

16. Objectives To ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future; To encourage the application of mental health knowledge in general healthcare and in social development; To promote community participation in the mental health service development; and To enhance human resource in mental health sub-specialties.

17. Components District and sub-district level activities under NHM: District Mental Health Program: Envisages provision of basic mental health care services at the community level: Service provision: provision of mental health out-patient & in-patient mental health services with a 10 bedded inpatient facility. Out-Reach Component: Satellite clinics: 4 satellite clinics per month at CHCs/ PHCs by DMHP team

18. Targeted Interventions: Life skills education & counselling in schools, College counselling services, Work place stress management, and Suicide prevention services

19. Sensitization & training of health personnel: at the district & sub-district levels Awareness camps: for dissemination of awareness regarding mental illnesses and related stigma through involvement of local PRIs, faith healers, teachers, leaders etc Community participation: Linkages with Self-help groups, family and caregiver groups & NGOs working in the field of mental health Sensitization of enforcement officials regarding legal provisions for effective implementation of Mental Health Act

20. As of now, 241 districts have been covered under the scheme & it is proposed to expand DMHP to all districts in a phased manner (Annexure-II) Manpower (on contractual basis): Psychiatrist, Clinical Psychologist, Psychiatric Nurse, Psychiatric Social Worker, Community Nurse, Monitoring & Evaluation Officer, Case Registry Assistant, Ward Assistant/ Orderly

21. Members of the Mental Health Team Psychiatrist Psychiatric nurse clinical specialist Registered nurse in a psychiatric unit Clinical psychologist Psychiatric social worker Psychiatric para -professionals Psychiatric nursing aids / attendants ECT Techniques Auxiliary personnel

22. Occupational therapist Recreational therapist Diversional play therapist Creative art therapist Clergymen

23. Psychiatrist:- The psychiatrist is a   doctor  with post-graduation in psychiatry with 2-3 years of residence training. The psychiatrist is responsible for diagnosis, treatment & prevention of mental disorders, prescribe medicines & somatic therapy & function as a leader of the mental health team. Psychiatric nurse clinical specialist:- The psychiatric nurse clinical specialist should have a master degree in nursing, preferably with post –graduate research work. She participates actively in primary, secondary & tertiary prevention of mental disorder & provides individual, group & family psychotherapy in a hospital & community setting. She also takes up the responsibility of teaching, administration & research.

24. Clinical psychologist:- The clinical psychologist holds a doctoral degree in clinical psychology & is registered with the clinical psychologist’s association. She/he conducts psychological, diagnosis tests, interprets & evaluates the finding of these tests & implements a program of behavior modification. Psychiatric social worker:- The psychiatric social worker is a graduate in social work & post-graduate in psychiatric social work. She/he assesses the individual, the family & community support system, helps in discharge planning, counseling for job placement & is aware of the state laws & legal rights of the patient & protects these rights.

25. Registered nurse in a psychiatric unit:- The registered nurse undergoes a general nursing & midwifery program or B.Sc nursing / post-basic B.Sc nursing program with added qualification such as diploma in psychiatric nursing. Diploma in nursing administration etc. This nurse is skilled in caring for the mentally ill, gives holistic care by assessing the patient’s mental, social, physical, psychological & spiritual needs.

26. Psychiatric para -professionals Psychiatric nursing aids / attendants:- They have high school training & are trained on the job. They aid maintaining the therapeutic environment & provide care under supervision. ECT Techniques:- They undergo training for 6-9 months. Their function is to keep ready the ECT under the supervision of a psychiatrist or anesthetist.

27. Auxiliary personnel:- They are volunteer housekeeper or clerical staff & require in-service education to interact with the patient therapeutically. Occupational therapist: -Occupational therapist goes through specialized training. He /she has a pivotal role to play by using manual & creative techniques to assess the interpersonal responses of the patient. Patients are helped to develop skill in the area of their choice & become economically independent. They are helped to work in sheltered workshop.

28. Recreational therapist:- The recreational therapist plans activities to stimulate the patient’s muscle co-ordination, interpersonal relationship & socialization. These approaches are need-based. Diversional play therapist:- Makes observation of a child / patient during his play. The behavior of the child while playing, the type of toys & his reaction toward the doll, beating, calling or throwing are the focus of attention.

29. Creative art therapist:- He/she is an art graduate & encourages the patient to express his work freely with colors & analysis the use of various colours , drawing of various scenes etc. this therapy helps in diagnosis & also in bringing the repressed feelings of the patient to the conscious level.  Clergymen:- These are religious persons who may be asked to come to the hospital unit once a week (depending on the patient’s religious faith) & have a spiritual talk with the patient.

30. Role of psychiatric mental health nurse Generalist Specialist Community mental health nurse Psychiatric home care nurse Forensic psychiatric nurse Case manager Gero -psychiatric nurse Parish nurse Psychiatric nurse Educator Nurse administrator Nurse psycho-pharmacologist Holistic nurse

31. Current issues and trends in care Trends in health care: a) Increased mental health problems b) Provision of quality and comprehensive services c) Multidisciplinary team approach d) Providing continuity of care Economic issues: industrialization, Urbanization and Raised standard of living Changes in illness orientation: Shift from illness to prevention, specific to holistic, quantity of care to quality care Changes in care delivery: Care delivery is shifted from institutional services to community services, genetic services to counseling services. Information and technology: Telenursing , Telemedicine, Mass media, Electronic system and nursing informatics Consumer empowerment: Increased consumer awareness, Awareness of community in early detection and treatment of mental illness as well as proper utilization of available psychiatric hospital

32. Deinstitutionalization: Bringing mental health patient out of the hospital and shifting care to community Demographic changes : Increasing number of elderly group and type of family Changes in need of patient: Wanting a more holistic orientation

33. FUNCTIONS OF MENTAL HEALTH NURSE IN VARIOUS SETTINGS Inpatient psychiatric ward: a)Provide environmental safety b)Perform psychosocial, high risk and social assessment c) Promotion of self care activities d)Delivering psycho-education e) Teaching social skills and stress management f) Supervise the work of subordinates Psychiatric outpatient department : a) Perform clinical assessment b)Assisting for psychometric assessment c)conducting group therapy d)Delivering psycho-education ECT treatment setting: a) Teaching the patient prior to ECT treatment b) Preparing the patient for ECT c) Providing care during procedure d)Assisting with post treatment

34. Psychotherapy Unit: a) Establishing a therapeutic relationship with the patient b) Providing an opportunity for the patient to release tension as problems are discussed c) Providing opportunity to practice new skills d) Reinforcing appropriate behavior as it occurs Daycare units : a) Performing clinical assessment b)Medication management c) Teaching social skills d) Counseling patient and family members Family therapy units : a) Assessing individual and family needs and resources b) Facilitation of family use of positive coping strategies c) Health education d) Delivering psycho-education Home setting, Child psychiatric ward, community mental health centre, Hospice care centre, Emergency department, Industrial medical centre and hospital for criminal Insane, Jails and Prison.

35. Concept of normal and abnormal behavior Medical model: Medical model considers organic pathology as the definite cause for mental disorder. According to this model abnormal people are those who have abnormality in their behavior observed by disturbance in thought, normal are those who are free from this disturbance. Statistical model: It involves the analysis of response on a test or a questionnaire or observation of some particular behavior variable. Socio-cultural model: The beliefs norms and taboos and values of a society have to be accepted and adopted by individual. Breaking any of these would be considered abnormal. Thus cultural background has to be taken in account when distinguishing between normal and abnormal behavior.

36. Health illness continuum

37. According to the Health-Illness continuum, health is dynamic. Our health moves back and forth within a continuum, with optimum health or highest health at one end and death or complete disability at the other end of this continuum. One day you may feel energetic, another might have a headache for all day long, while on the third day you may feel fine again. These situations suggest that our health never remains constant and it changes or fluctuates throughout one’s life. According to this model, since our health continuously changes; therefore, our adaption or response to that change matters most as it affects our health directly. For the same stressful situation, one person might respond positively while another person might get anxious. The person who responded positively will have better health than the second one.